Method of Using a Combination Driver/Anti-Rotation Handle for Shoulder Arthroplasty

ABSTRACT

A method of preparing a shoulder to receive a glenoid component includes accessing a glenoid of a shoulder, rotationally coupling a distal portion of a combination device to an instrument, applying a torque to a proximal portion of the combination device, transferring the applied torque from the proximal portion to the distal portion through a pivotable connection, rotating the instrument using the transferred applied torque, and reaming a portion of the glenoid with a rotating reaming section of the instrument using the transferred applied torque.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.13/363,583, which was filed Feb. 1, 2012 which is a continuation-in-partof U.S. patent application Ser. No. 13/051,026, entitled “CombinationReamer/Drill Bit for Shoulder Arthroscopy”, which was filed on Mar. 18,2011, the entire contents of which are each incorporated herein byreference.

TECHNICAL FIELD OF THE INVENTION

The present invention relates generally to the field of orthopedics,and, more particularly, to glenoid component apparatuses for shoulderarthroplasty and methods for using them.

BACKGROUND

As depicted in FIG. 1, a typical shoulder or glenohumeral joint isformed in a human body where the humerus 10 movably contacts the scapula12. The scapula 12 includes a glenoid fossa 14 that forms a socketagainst which the head of the humerus 10 articulates. At this socket,the scapula 12 includes cartilage 16 that facilitates such articulation.Beneath the cartilage is subchondral bone 18 that forms a wall of aglenoid vault 20 that defines a cavity which contains cancellous bone22. The subchondral bone 18 that forms the glenoid vault 20 defines aglenoid rim 24 at a periphery of the glenoid vault 20 that is attachedto the cartilage 16. During the lifetime of a patient, the glenoid fossa14 may become worn, especially at its posterior and/or superior portionsthereby causing severe shoulder pain and limiting the range of motion ofthe patient's shoulder joint. To alleviate such pain and increase thepatient's range of motion, a shoulder arthroplasty may be performed.Arthroplasty is the surgical replacement of one or more bone structuresof a joint with one or more prostheses.

Shoulder arthroplasty often involves replacement of the glenoid fossa ofthe scapula with a prosthetic glenoid component. The conventionalglenoid component typically provides a generally laterally or outwardlyfacing generally concave bearing surface against which a prosthetichumeral head (or, alternatively, the spared natural humeral head in thecase of a glenoid hemi-arthroplasty) may bear during operation of thejoint. The conventional glenoid component typically also includes agenerally medially or inwardly projecting stem for fixing the glenoidcomponent in a cavity constructed by suitably resecting the glenoidfossa 14 and suitably resecting cancellous bone 22 from the glenoidvault 20.

The goal of shoulder arthroplasty is to restore normal kinematics to theshoulder. Accordingly, known systems attempt to replicate the normalkinematics by carefully controlling the geometry of the articulatingsurfaces in the joint as well as the positioning of the prostheses inthe bones in which the prostheses are implanted. Thus, the articulatingsurface of a humeral component is typically spherical and positioning ofthe humeral component is accomplished by using the anatomical neck ofthe humerus as the reference plane for reconstruction of the humeralhead.

Traditionally, shoulder joints have been understood to exhibittranslation of the humeral component on the glenoid component inaddition to rotation. Thus, the articulating surface of the glenoid istypically formed with a radius of curvature that is much larger than theradius of curvature of the humeral component. The increased radius ofcurvature of the glenoid articulating surface can be from 2-6 mm largerthan the radius of curvature for the humeral component in these systems.

In known systems, the glenoid component is positioned in the geometriccenter of the glenoid fossa. The geometric center is established bygenerating a line from the most superior point of the glenoid rim to themost inferior point of the glenoid rim (“Saller's line”). A second lineis generated between the most posterior point of the glenoid rim and themost anterior point of the glenoid rim. The intersection of the twogenerated lines is considered to be the geometric center of the areacircumscribed by the glenoid rim. By way of example, FIG. 2 depicts asagittal view of the scapula 12. In FIG. 2, Saller's line 30 extendsbetween the most superior point 32 of the glenoid rim 24 to the mostinferior point 34 of the glenoid rim 24. A second line 36 extends fromthe most posterior point 38 of the glenoid rim 24 and the most anteriorpoint 40 of the glenoid rim. The geometric center 42 of the glenoidfossa 14 is located at the intersection of the line 36 and Saller's line30. As used herein, the terms anterior, posterior, superior, andinferior, unless otherwise specifically described, are used with respectto the orientation of the scapula 12 as depicted in FIG. 2.

Once a surgeon determines the placement of the glenoid component, aguide pin is positioned through the glenoid fossa. A reamer is then usedto shape the scapula to receive a glenoid component, typically byforming a cavity in the glenoid vault. For glenoid components includinga center peg for fixation of the glenoid component within the glenoidvault, a bore is drilled using the guide pin as a guide. The guide pinis then removed. For glenoid components including offset pegs inaddition to the center peg for fixation of the glenoid component withinthe glenoid vault, a drill guide is introduced into the prepared cavityand additional bores are drilled for each of the offset pegs. A trialglenoid component is then implanted in the prepared cavity and, if thefit appears to be satisfactory, the trial is removed and a glenoidcomponent is implanted in the prepared cavity.

There exists a need for a simplified method of implanting a glenoidcomponent. There is a further need for reducing the instrumentationrequired to properly prepare the scapula to receive a glenoid component.

SUMMARY OF THE INVENTION

The present invention in one embodiment provides an instrumentation kitfor use in preparing a bone to receive a prosthetic component whichincludes at least one first combination device, the at least one firstcombination device including a proximal portion configured to couplewith a torque providing device and a distal portion configured to couplewith a first instrument, the at least one first combination devicepivotable between a first position whereat the proximal portion and thedistal portion are (i) longitudinally aligned and (ii) configured totransfer a torque received by the proximal portion to the distalportion, and a second position whereat the proximal portion and thedistal position are (i) not longitudinally aligned and (ii) configuredto transfer a torque received by the proximal portion to the distalportion.

In another embodiment, a method of preparing a shoulder to receive aglenoid component includes accessing a glenoid of a shoulder,rotationally coupling a distal portion of a combination device to aninstrument, applying a torque to a proximal portion of the combinationdevice, transferring the applied torque from the proximal portion to thedistal portion through a pivoting connection, rotating the instrumentusing the transferred applied torque, and reaming a portion of theglenoid with a rotating reaming section of the instrument using thetransferred applied torque.

The above-noted features and advantages of the present invention, aswell as additional features and advantages, will be readily apparent tothose skilled in the art upon reference to the following detaileddescription and the accompanying drawings, which include a disclosure ofthe best mode of making and using the invention presently contemplated.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts a coronal view of an anatomically normal shoulder joint.

FIG. 2 depicts a sagittal view of the shoulder joint of FIG. 1;

FIG. 3 depicts a bottom perspective view of a circular glenoid componentthat may be implanted in a scapula in accordance with principles of theinvention;

FIG. 4 depicts a bottom plan view of the circular glenoid component ofFIG. 3;

FIG. 5 depicts a side plan view of the circular glenoid component ofFIG. 3;

FIG. 6 depicts a side perspective view of a combination reamer/drilldevice that may be used to simultaneously form a bore for receiving apeg of a glenoid component and to ream a glenoid fossa to receive theglenoid component;

FIG. 7 depicts a bottom perspective view of the combination device ofFIG. 6 showing the guide bore extending from a distal tip of thecombination device;

FIG. 8 depicts a bottom plan view of the combination device of FIG. 6;

FIG. 9 depicts a side plan view of the combination device of FIG. 6showing the guide bore extending to a drive section which in thisembodiment is a hexagonally shaped bore in a body section of thecombination device;

FIG. 10 depicts a perspective view of a combination powerextension/anti-rotation handle which may be used with the combinationdevice of FIG. 6 to couple a power rotary tool (not shown) to thecombination device;

FIG. 11 depicts a bottom plan view of the combination powerextension/anti-rotation handle of FIG. 10 showing a guide bore whichextends from a distal tip of the lower portion;

FIG. 12 depicts a side cross sectional view of the combination powerextension/anti-rotation handle of FIG. 10;

FIG. 13 depicts a medical procedure that may be used to implant thecircular glenoid component of FIG. 3 into a scapula using thecombination device of FIG. 10;

FIG. 14 depicts a perspective view of the scapula of FIG. 2 with a guidewire positioned in the scapula using a guide template and a guidetemplate manipulator;

FIG. 15 depicts a partial cross-sectional view of the scapula of FIG. 14with the combination reamer/drill device of FIG. 6 guided to a locationadjacent to the glenoid fossa by the guide wire of FIG. 14;

FIG. 16 depicts a partial cross-sectional view of the scapula of FIG. 14with the combination power extension/anti-rotation handle of FIG. 10coupled to the combination reamer/drill device of FIG. 6, both thecombination power extension/anti-rotation handle and the combinationreamer/drill device guided to a location adjacent to the glenoid fossaby the guide wire of FIG. 14;

FIG. 17 depicts a partial cross-sectional view of the scapula of FIG. 14and the coupled combination power extension/anti-rotation handle and thecombination reamer/drill devices of FIG. 16 after the combinationreamer/drill device has been used to form a bore in preparation forimplanting the glenoid component of FIG. 3 into the scapula;

FIG. 18 depicts a partial cross-sectional view of the scapula of FIG. 14and the coupled combination power extension/anti-rotation handle and thecombination reamer/drill devices of FIG. 16 after the combinationreamer/drill device has been used to simultaneously ream the glenoidfossa and form a bore in preparation for implanting the glenoidcomponent of FIG. 3 into the scapula;

FIG. 19 depicts a perspective view of the scapula of FIG. 14 after thecombination power extension/anti-rotation handle has been withdrawnalong the guide wire 236 to a location that allows pivoting of theproximal portion of the combination power extension/anti-rotationhandle;

FIG. 20 depicts a perspective view of the combination powerextension/anti-rotation handle after the proximal portion of thecombination power extension/anti-rotation handle has been pivoted;

FIG. 21 depicts a perspective view of the scapula of FIG. 14 after thepivoted combination power extension/anti-rotation handle of FIG. 20 hasbeen guided by the wire guide of FIG. 14 and coupled with thecombination reamer/drill device of FIG. 6 allowing a user to manuallyorient the combination reamer/drill device on the scapula;

FIG. 22 depicts a perspective view of the scapula of FIG. 14 with thecombination reamer/drill device of FIG. 6 used to guide a drill bit toform a bore to receive an offset peg of the glenoid component of FIG. 3while the pivoted combination power extension/anti-rotation handle ofFIG. 20 has been used to manually stabilize the combination reamer/drilldevice on the scapula; and

FIG. 23 depicts a perspective view of the combination reamer/drilldevice of FIG. 6 and drill bit of FIG. 22 with the pivoted combinationpower extension/anti-rotation handle of FIG. 20.

DETAILED DESCRIPTION

Like reference numerals refer to like parts throughout the followingdescription and the accompanying drawings.

FIGS. 3-5 depict a glenoid component 100. The glenoid component 100includes a body portion 102 including a spherical articulating surface104 and an opposite bone contacting surface 106. An outer wall 108extends away from the bone contacting surface 106 and defines an outerperiphery of the body portion 102. The bone contacting surface 106 isgenerally convex. A finned center peg 110 extends away from the nadir ofthe bone contacting surface 106 as viewed in FIG. 5. Three offset pegs112, 114, and 116 extend away from the bone contacting surface 106 atlocations between the center peg 110 and the outer wall 108. The nadir118 of the spherical articulating surface 104 is located on thecenterline 120 of the glenoid component 100.

The glenoid component 100 in this embodiment is an integrally formedunit made from a durable biocompatible plastic or any other suitabledurable biocompatible material. For example, the glenoid component 100may be made from a polyethylene. One particular polyethylene that iswell suited for glenoid component 100 is a high molecular weightpolyethylene, for example ultra-high molecular weight polyethylene(“UHMWPE”). One such UHMWPE is sold as by Johnson & Johnson of NewBrunswick, N.J. as MARATHON™ UHMWPE and is more fully described in U.S.Pat. Nos. 6,228,900 and 6,281,264 to McKellop, which are incorporatedherein by reference.

In embodiments wherein the articulating surface 104 and the otherportions of the glenoid component 100 are made from different materials,the portions of the glenoid component 100 other than the articulatingsurface 104 may be made from a suitable biocompatible metal such as, forexample, a cobalt chromium alloy, a stainless steel alloy, a titaniumalloy, or any other suitable durable material. In these embodiments, thearticulating surface 104 is secured to the body portion 102 in anysuitable manner. For example, articulating surface 104 may be bonded tobody portion 102, or articulating surface 104 could be made frompolyethylene and compression molded to body portion 102. Alternately,the articulating surface 104 may be glued to the body portion 102 by,for example, an adhesive. Alternatively, articulating surface 104 may bemechanically interlocked to the body portion 102 by taper locking orotherwise press-fitting the articulating surface 104 into the body 102and the body 102 may include any other suitable interlocking features,for example, rib(s), lip(s), detent(s), and/or other protrusion(s) andmating groove(s), channel(s), or indent(s) (not shown).

In alternative embodiments, one or more of the outer wall 108, the bonecontacting surface 106, the center peg 110 and the offset pegs 112, 114,and 116 may include a porous coating to facilitate bone in-growth intothe glenoid component 100. The porous coating may be any suitable porouscoating and may for example be POROCOAT®, a product of Johnson & Johnsonof New Brunswick, N.J. and more fully described in U.S. Pat. No.3,855,638 to Pilliar, which is incorporated herein by reference.

In order to implant the glenoid component 100 into a scapula, thescapula must first be prepared to receive the glenoid component 100. Adevice which can be used to prepare the scapula to receive the glenoidcomponent 100 is depicted in FIGS. 6-9. With reference to FIGS. 6-9, acombination reamer/drill device 130 includes a drive section 132, a bodysection 134, and a drill or boring section 136. The drive section 132 inthis embodiment is a hexagonally shaped bore defined in the body section134.

A number of reaming fins 140 extend from the lower central portion ofthe body section 134 toward the drill section 136. The reaming fins 140curve proximally and outwardly from the lower central portion of thebody section 134 to the outer periphery of the body section 134. Thereaming fins 140 include an arcuate leading edge 142. The body section134 defines a number of through-holes at locations between adjacentreaming fins 140. The through-holes in the embodiment of FIGS. 6-9include three drill guides 146 and three ports 148.

The drill section 136 extends away from the body section 134 to a distaltip 150. Two flutes 152 and 154 extend helically about the drill section136 between the body section 134 and the distal tip 150. A guide bore156 extends from the distal tip 150 to the drive section 132.

As discussed in further detail below, a kit may include one or morecombination reamer/drill devices 130 along with various instrumentationto facilitate use of the combination reamer/drill device 130. By way ofexample, FIGS. 10-12 depict a combination power extension/anti-rotationdevice 160 that may be included in the kit. The combination powerextension/anti-rotation device 160 includes a longitudinally extendingproximal portion 162 and a longitudinally extending distal portion 164.The proximal portion 162 includes a power receiving portion 166 and ajunction portion 168. The power receiving portion 166 is sized andconfigured to couple with a power tool (not shown) and includes a pairof opposing power receiving flats 170 and a pair of coupling grooves 172and 174 which extend about the power receiving portion 166 between thepower receiving flats 170.

The junction portion 168 includes two tines 180/182 which define areceiving area 184 therebetween. A guide bore 186 extends from thereceiving area 184 to the proximal tip 188 of the proximal portion 162.Two bores 190/192 extend through the respective tines 180/182.

The distal portion 164 includes a power transfer portion 200 at a distalend 202. The power transfer portion 200 is shaped to be complimentary tothe drive section 132 of the combination reamer/drill 130. In theembodiment of FIGS. 10-12, the power transfer portion 200 is thus ahexagonally shaped protrusion sized to fit within the drive section 132.

A junction portion 204 is located at a proximal end 206 of the distalportion 164. The junction portion 204 includes two tines 208/210 whichdefine an upper receiving area 212 and a lower receiving area 214therebetween. A guide bore 216 extends from the lower receiving area 214to the distal end 202 of the distal portion 164. Two bores 218/220extend through the respective tines 208/210. The bores 218/220 arecountersunk so that two pins 222/224 may be received therein and beflush with the outer surface of the tines 208/210.

When the combination power extension/anti-rotation handle 160 isassembled, the tines 180/182 of the proximal portion 162 are receivedwith in the upper receiving area 212 of the distal portion 162.Additionally, the bores 190/192 are aligned with the bores 218/220,respectively. The pin 222 is positioned within the aligned bores190/218, while the pin 224 is positioned within the aligned bores192/220. The pins 222/224 and bores 190/192/218/220 are configured toallow the proximal portion 162 to pivot with respect to the distalportion 164 about an axis defined by the pins 222/224. To this end, thepins 222/224 in one embodiment are in the form of rivets. In anotherembodiment, the pins 222/224 are threadedly engaged with the bores190/192, respectively and configured to articulate with the bores218/220.

Additionally, the guide bore 186 and the guide bore 216 lie within thesame plane when the combination power extension/anti-rotation handle 160is assembled. As the proximal portion 162 is pivoted with respect to thedistal portion 164, the guide bore 186 pivots within that same plane.Accordingly, the guide bores 186 and 216 may be pivoted into alignmentwith each other. When the guide bores 186 and 216 are aligned, theproximal portion 162 and the distal portion 164 are longitudinallyaligned as depicted in FIG. 10.

A kit including the combination reamer/drill device 130 and the powerextension/anti-rotation handle 160 may be used in preparing a shoulderto receive a glenoid component such as glenoid component 100 inaccordance with a procedure 230 depicted in FIG. 13. Initially, ascapula is accessed at block 232 in accordance with a desired surgicalapproach. At block 234, a guide wire, which may be provided in a kitalong with other instrumentation used in the procedure 230, ispositioned on the scapula. Positioning of the guide wire may be computeraided. In one embodiment, the guide wire is positioned based uponidentification of the center of an inferior glenoid circle. By way ofexample, FIG. 14 depicts a guide wire 236 implanted into a glenoid 238of a scapula 240. In the embodiment of FIG. 20, the guide wire 236 hasbeen positioned with the aid of a guide plate 242 and a guide platemanipulator 244.

Once the guide wire is positioned, a combination reamer/drill device 130is positioned with the guide bore 156 aligned with the guide wire 236.The combination reamer/drill device 130 is then moved toward the guidewire 236 and at block 246 the guide wire 236 is used to guide thecombination reamer/drill device 130 to a location adjacent to theglenoid 238 of the scapula 240 as depicted in FIG. 15.

At block 248, a combination power extension/anti-rotation handle 160 iscoupled to the combination device 130 by first aligning the guide bore216 (see FIG. 12) with the guide wire 236. The combination powerextension/anti-rotation handle 160 is then moved over the guide wire 236until the guide wire 236 extends through the guide bore 216 and into thelower receiving area 214. The proximal portion 162 is then pivoted withrespect to the distal portion 164 as necessary to align the guide bore186 with the guide wire 236. The combination powerextension/anti-rotation handle 160 is then moved over the guide wire 236until the power transfer portion 200 is adjacent to the drive section132 of the combination reamer/drill device 130. If needed, thecombination power extension/anti-rotation handle 160 is rotated on theguide wire 236 to rotationally align the shaped power transfer portion200 with the shaped drive section 132 and the power transfer portion 200is inserted into the drive section 132 resulting in the configuration ofFIG. 16.

A rotary tool (not shown) is then coupled to the combination powerextension/anti-rotation handle 160 at block 250. Thus, the rotary toolis coupled to the power receiving portion 166 of the proximal portion162 so as to be indirectly coupled to the combination reamer/drilldevice 130.

Power is then applied to the rotary tool causing the rotary tool torotate the combination power extension/anti-rotation handle 160. Rotaryforce is transferred to the drive section 132 of the combinationreamer/drill device 130 through the power transfer portion 164 (see FIG.12). More specifically, torque is passed from the rotary tool to thepower receiving portion 166. The tines 180/182/208/210 are configuredsuch that the torque received by the proximal portion 162 is transferredto the tines 208/210 through the tines 180/182. The torque is thentransferred from the power transfer portion 200 to the drive section132, causing the combination reamer/drill device 130 to rotate.

As the combination reamer/drill device 130 initially rotates about theguide wire 236, the drill section 136 contacts the glenoid 238 andbegins to bore a hole in the glenoid 238. The reaming fins 140, however,are initially spaced apart from the glenoid 238 as depicted in FIG. 17.Accordingly, no reaming occurs. As a hole is formed in the glenoid 238by the drill section 136, the combination reamer/drill device 130 isguided by the guide wire 236 such that the reaming fins 140 come intocontact with the glenoid 238 as depicted in FIG. 18. Continued rotationof the combination reamer/drill device 130 with the rotary tool thuscauses simultaneous reaming of the glenoid 238 with the reaming fins 140and boring of the scapula 240 with the drill section 136 at block 252.

Once the glenoid 238 has been reamed to the desired depth, the powertool is de-energized and disconnected at block 254. The size of thedrill section 132, both in length and diameter, is selected to becomplimentary to the size of the center peg 110 of the glenoid component100. Thus, upon completion of the reaming, the bore formed by the drillsection 132 is sized to receive the finned center peg 110.

The combination power extension/anti-rotation handle 160 is then backedaway from the combination reamer/drill device 130 along the guide wire236 at block 256 until the end of the guide wire 126 is located withinthe receiving area 184 of the proximal portion 162 resulting in theconfiguration of FIG. 19. While the guide wire was within the guide bore186 of the proximal portion 162, the proximal portion 162 was maintainedin alignment with the distal portion 164 which enables smooth transferof torque through the combination power extension/anti-rotation handle160. Once the guide wire 236 is no longer within the guide bore 186,however, the proximal portion 162 may be pivoted with respect to thedistal portion 164 to the configuration of FIG. 20 (block 258).

At block 260, the combination power extension/anti-rotation handle 160is coupled to the combination device 130 substantially in the mannerdescribed above. Since the guide wire 236 does not extend through theproximal portion 162, however, the proximal portion 162 may be used as ahandle to rotate the coupled combination power extension/anti-rotationhandle 160 and combination reamer/drill device 130 about an axis definedby the guide wire 236 as indicated by the arrow 262 of FIG. 21. Thecombination power extension/anti-rotation handle 160 is thus used toalign a drill guide 146 in the combination reamer/drill device 130 witha desired location (block 264). In one embodiment, a handle similar tothe handle shown attached to the guide plate manipulator 244 of FIG. 14may be included in the kit. Such a handle may be removably coupled tothe power receiving portion 166 of the proximal portion 162 tofacilitate manipulation of the combination power extension/anti-rotationhandle 160.

The ability to pivot the proximal portion 162 provides a surgeon with arelatively unobstructed view of the combination reamer/drill device 130.Accordingly, the surgeon may view the reamed surface of the glenoid 238through the drill guides 146. This allows a surgeon to view the locationin the scapula 240 at which the offset fixation pegs 112, 114, and 116of the glenoid component 100 will be anchored. In the embodiments inthis example wherein the number and positioning of the drill guides 146are complimentary to the number and positioning of the offset fixationpegs 112, 114, and 116, the surgeon may orient the combinationreamer/drill device 130 such that each of the drill guides 146 isaligned with portions of the scapula 240 that can provide a good anchorfor the offset fixation pegs 112, 114, and 116.

Once the combination reamer/drill device 130 is aligned at the block264, a drill bit is inserted through one of the drill guides 146 todrill an additional bore at a location spaced apart from the first boreformed using the drill section 136 at block 230. By way of example,FIGS. 22 and 23 depict a drill bit 266 positioned in a drill guide 146of the combination device 130. The combination powerextension/anti-rotation handle 160 may be used to steady the combinationreamer/drill device 130 during the drilling process. The offset of theproximal portion 162 from the axis defined by the wire guide 236 resultsin a mechanical advantage in maintaining the combination reamer/drilldevice 130 at the desired orientation. Blocks 264 and 268 may berepeated as desired to form additional holes.

Once all of the desired holes are formed, the combination reamer/drilldevice 130 is removed at block 270. The combination powerextension/anti-rotation handle 160 may be used to aid in removal of thecombination reamer/drill device 130. At block 272, the glenoid componentis implanted. In this example, the glenoid component 100 has a lowerbone contacting surface 106 shaped complimentary to the reamingcross-section of the reaming fins 140. Thus, in this example the lowerbone contacting surface 106 is curved complimentary to the distal curveof the reaming fins 140. In other embodiments, the reaming fins 140 maybe configured to produce a flat bottomed area if a glenoid componentwith a flat lower bone contacting surface is used. Accordingly, a kit inone embodiment includes different combination devices with differentlyshaped reaming cross-sections.

Moreover, while in the embodiment of FIGS. 10-12 the proximal portion162 is only pivotably connected to the distal portion 164, in anotherembodiment the proximal portion is both pivotably and slidably connectedto the distal portion. This can be accomplished by providinglongitudinal slots connected to the bores 218/220. In this embodiment,once the proximal portion is aligned with the distal portion, theproximal portion may be moved toward the distal portion. Accordingly, inaddition to torque being passed through the tines in the junctionportion, additional features may be incorporated in the proximal anddistal portions which are selectively interlocked. This arrangementallows for a more robust connection between the proximal portion and thedistal portion which is useful in embodiments wherein weaker materialsare desired to be used in forming a combination powerextension/anti-rotation handle.

In yet another embodiment, the guide bores in the proximal portion andthe distal portion are positioned substantially immediately adjacent toone another when the proximal and distal portions are aligned. In thisembodiment, pivoting between the proximal and distal portions is enabledby moving the combination power extension/anti-rotation handle such thatthe wire guide does not extend into the guide bore in the proximalportion.

The foregoing description of the invention is illustrative only, and isnot intended to limit the scope of the invention to the precise termsset forth. Further, although the invention has been described in detailwith reference to certain illustrative embodiments, variations andmodifications exist within the scope and spirit of the invention asdescribed and defined in the following claims.

What is claimed is:
 1. A method of preparing a shoulder to receive aglenoid component comprising: accessing a glenoid of a shoulder;rotationally coupling a distal portion of a combination device to aninstrument; applying a torque to a proximal portion of the combinationdevice; transferring the applied torque from the proximal portion to thedistal portion through a pivotable connection; rotating the instrumentusing the transferred applied torque; and reaming a portion of theglenoid with a rotating reaming section of the instrument using thetransferred applied torque.
 2. The method of claim 1, furthercomprising: pivoting the proximal portion with respect to the distalportion after reaming the portion of the glenoid; rotating theinstrument using the pivoted proximal portion; and forming a bore in theglenoid using a first drill guide defined by the instrument.
 3. Themethod of claim 1, wherein rotationally coupling the combination deviceand the instrument comprises: positioning a wire guide in the shoulder;inserting the wire guide into a first guide bore in the instrument; andinserting the wire guide into a second guide bore in the distal portion.4. The method of claim 3, wherein rotationally coupling the combinationdevice and the instrument further comprises: inserting the wire guideinto a third guide bore in the proximal portion.
 5. The method of claim4, wherein pivoting the proximal portion with respect to the distalportion comprises: moving the proximal portion away from the instrumentso that the wire guide is no longer within the third guide bore.
 6. Themethod of claim 5, wherein pivoting the proximal portion with respect tothe distal portion further comprises: pivoting the proximal portionabout a pin extending through a first tine of the proximal portion and asecond tine of the distal portion.
 7. The method of claim 5, whereinmoving the proximal portion away from the instrument decouples thedistal portion of the combination device and the instrument, the methodfurther comprising: moving the distal portion along the guide wiretoward the instrument using the pivoted proximal portion; rotationallyaligning the distal portion and the instrument using the pivotedproximal portion; and recoupling the distal portion and the instrumentusing the pivoted proximal portion.
 8. The method of claim 7, furthercomprising: rotating the recoupled distal portion and instrument usingthe pivoted proximal portion.